胃脘近心之分。而与脾膜相连。故其疼也。俗指为心。而古则称脾耳。盖脾之脉贯于胃。而
为之行其津液。故犯贼风虚邪者。阳受之。饮食不节。起居不时者。阴受之。于是发为中脘痛。
方书分为九种。一曰客寒犯胃。一曰寒郁为热。则新与久之别也。一曰痰涎在膈。一曰虫积在中。
则呕痰与清水之别也。一曰气。一曰食。则胀与满之分也。一曰血。一曰火。则喜热与寒之分也。
一曰虚。则与实殊者。喜手按不可按之分也。然此特其大概耳。要之胃气。人之所赖而生者。根据
中焦以腐化。藉脾气以消磨。一或阻隔。失其健运之常。则气血食积痰饮。皆得乘之而为患。使
徒知治标。而不探其本。将愈攻愈虚。虽或少宽于旦夕。实则致病于将来。以致触而即发。久而
弥剧者。未必非治之失宜故也。故凡疗脾疼者。脉见 弱。中气已虚。即宜归脾暂去当归、 、
术。少加柴胡。或兼二陈。有食加枳实。有寒加炮姜。有热加山栀。先固其中气。则痛不致于伤
胃。脾阴不竭。而胃阳有助。心君宁而肝不敢乘。肾独能凌乎。一举而诸善备焉。若夫治实之法。方书具在。
一客寒犯胃。或过食生冷。中脘疼痛。手足厥逆。脉见弦紧。用草豆蔻汤。
一心痛稍久。寒郁为热。烦躁呕酸。面赤脉数者。山栀仁汤。
一痰涎在胸膈。呕逆大痛不可忍。脉来洪滑者。枳缩二陈汤。
一虫痛时作时止。口吐清水。或如咬状。用川楝子汤。
一心痛因怒而发。心膈胀闷。脉沉伏。四股冷者。木香汤。
一心痛因面食坚硬等味。过用不化。用莱菔子汤。
一心痛素喜食热物者。瘀血停于胃口也。桃仁玄胡汤。
一中气不足。思虑过度。饥饱失时。劳役不节者。归脾汤、六君子汤。
草豆蔻汤
草豆蔻（煨） 高良姜 广皮 陈神曲（炒） 吴茱萸（汤泡五分） 茯苓 半夏（各一钱） 炙甘草（三分）
煨姜一片。水煎。非脉实症寒者。勿轻用。
山栀仁汤
山栀（炒黑） 半夏 广皮（各一钱） 竹茹（一团） 木香（五分） 甘草（炙三分） 黄连（七分茱制）
灯芯一握。水煎。
枳缩二陈汤
枳实（麸炒） 熟半夏（各钱半） 茯苓 砂仁（炒熟） 广陈皮（各一钱） 炙甘草（三分）
姜三片。水煎。
川楝子汤
川楝肉（二钱） 木香（七分） 槟榔 熟半夏 枳实（曲炒） 广皮（各一钱） 炙甘草（三分）
生姜水煎。入砂糖少许和服。
木香汤
木香 香附（醋炒） 青皮 广皮 枳实（麸炒） 柴胡 苏梗（各一钱） 炙草（三分）
炒熟砂仁末一钱。水煎。
莱菔子汤
莱菔子（焙研） 山楂（各钱半） 浓朴（姜制） 枳实 广皮（各一钱） 蓬术（八分醋制） 炙甘草（三分）
姜三片。水煎。
桃仁延胡汤
桃仁泥（十粒） 木香 炮姜（各五分） 炙甘草（三分） 香附（醋炒） 延胡索（醋煮）
广皮（各一钱） 钩藤 泽兰（各钱半）
砂仁五分。水煎。
归脾汤
人参 石斛（盐水炒） 远志内（甘草汤净焙） 茯神 枣仁（炒熟研） 白退术（土炒各一钱）
炮姜 木香 石菖蒲（各五分） 柴胡 炙甘草（各三分） 当归身（七分）
桂圆肉五枚。水煎。
六君子汤
人参 半夏 白术（土炒） 茯苓 广皮（各一钱） 钩藤（一钱） 木香（五分） 甘草（炙三分）
枣二枚。姜三片。水煎。
胃脘部靠近心脏的部位，与脾膜相连。因此这里的疼痛，俗人常误认为是心痛，而古人则称之为脾痛。这是因为脾的经脉贯穿胃部，并为胃输送津液。所以，遭受贼风虚邪侵袭的，阳气先受病；饮食不节制、起居无规律的，阴气先受病。于是便引发中脘痛。
医书将中脘痛分为九种类型：一是客寒犯胃，二是寒郁化热，这是新病与久病的区别；三是痰涎停留在膈间，四是虫积在腹部，这是呕吐痰涎与清水的区别；五是气滞，六是食积，这是腹胀与腹满的区别；七是血瘀，八是火盛，这是喜热饮与喜冷饮的区别；九是虚证，这与实证不同，表现为喜欢按压和不喜欢按压的区别。然而这仅仅是大概的分类。归根结底，胃气是人赖以生存的根本，依靠中焦来腐熟水谷，借助脾气来消磨食物。一旦气机阻隔，失去正常的健运功能，那么气血停滞、食积、痰饮等邪气便会乘虚而入造成危害。如果只知道治疗表面症状，而不探究根本原因，将会导致越攻伐身体越虚弱，虽然短期内可能稍感宽舒，实际上却为将来埋下致病隐患，以致于稍微触动就发作，时间久了病情更加严重，这未必不是治疗不当造成的后果。
因此，凡是治疗脾（胃）痛的，如果脉象微弱，说明中气已经虚弱，应当立即使用归脾汤，但要去掉当归、白术，少量加入柴胡；或者配合二陈汤使用。如果有食积，加入枳实；如果有寒邪，加入炮姜；如果有热邪，加入山栀。先稳固中气，那么疼痛就不会伤害到胃。脾阴不枯竭，胃阳就有辅助，心主安宁而肝不敢乘虚侵犯，肾又怎能单独凌驾呢？这样一举而多种益处兼备。至于治疗实证的方法，医书中已有记载。
1. 客寒犯胃，或者过食生冷，导致中脘疼痛，手足冰冷，脉象弦紧，使用草豆蔻汤。
2. 心痛时间稍长，寒郁转化为热，出现烦躁、呕吐酸水、面色发红、脉数等症状，使用山栀仁汤。
3. 痰涎停留在胸膈，呕吐逆气，剧烈疼痛难以忍受，脉象洪大滑利，使用枳缩二陈汤。
4. 虫痛时作时止，口吐清水，或者感觉像被咬一样，使用川楝子汤。
5. 心痛因愤怒而发作，心膈部位胀闷，脉象沉伏，四肢发冷，使用木香汤。
6. 心痛因为食用面食等坚硬食物，过度食用无法消化，使用莱菔子汤。
7. 素来喜欢吃热物的心痛患者，是因为瘀血停留在胃口，使用桃仁玄胡汤。
8. 中气不足，思虑过度，饥饱无常，劳累过度且没有节制的人，使用归脾汤或六君子汤。
【方剂组成】
草豆蔻汤
草豆蔻（煨制）、高良姜、广皮、陈神曲（炒制）、吴茱萸（用汤浸泡五分）、茯苓、半夏（以上各一钱）、炙甘草（三分）。加煨姜一片，水煎服。如果不是脉实症寒的患者，不要轻易使用。
山栀仁汤
山栀（炒黑）、半夏、广皮（以上各一钱）、竹茹（一团）、木香（五分）、甘草（炙三分）、黄连（七分，用茱萸汁制）。加灯芯一握，水煎服。
枳缩二陈汤
枳实（麸炒）、熟半夏（以上各钱半）、茯苓、砂仁（炒熟）、广陈皮（以上各一钱）、炙甘草（三分）。加姜三片，水煎服。
川楝子汤
川楝肉（二钱）、木香（七分）、槟榔、熟半夏、枳实（曲炒）、广皮（以上各一钱）、炙甘草（三分）。加生姜水煎，调入少许砂糖和服。
木香汤
木香、香附（醋炒）、青皮、广皮、枳实（麸炒）、柴胡、苏梗（以上各一钱）、炙甘草（三分）。加炒熟的砂仁末一钱，水煎服。
莱菔子汤
莱菔子（焙干研碎）、山楂（以上各钱半）、浓朴（姜制）、枳实、广皮（以上各一钱）、蓬术（八分，醋制）、炙甘草（三分）。加姜三片，水煎服。
桃仁延胡汤
桃仁泥（十粒）、木香、炮姜（以上各五分）、炙甘草（三分）、香附（醋炒）、延胡索（醋煮）、广皮（以上各一钱）、钩藤、泽兰（以上各钱半）。加砂仁五分，水煎服。
归脾汤
人参、石斛（盐水炒）、远志肉（甘草汤洗净焙干）、茯神、枣仁（炒熟研碎）、白术（土炒，以上各一钱）、炮姜、木香、石菖蒲（以上各五分）、柴胡、炙甘草（以上各三分）、当归身（七分）。加桂圆肉五枚，水煎服。
六君子汤
人参、半夏、白术（土炒）、茯苓、广皮（以上各一钱）、钩藤（一钱）、木香（五分）、甘草（炙三分）。加大枣二枚、姜三片，水煎服。
The epigastric region is close to the heart and connected to the spleen membrane. Therefore, pain in this area is commonly mistaken by laypeople as Heart Pain (Xintong), while ancient texts refer to it as Spleen Pain. This is because the Spleen meridian passes through the Stomach and transports fluids there. Thus, when attacked by pathogenic winds and empty evils, Yang is affected first; when diet is irregular or daily routine is unregulated, Yin is affected first. Consequently, Middle Epigastric Pain (Zhongwan Tong) develops.
Medical texts classify Middle Epigastric Pain into nine types: one is Guest Cold invading the Stomach; another is Cold stagnating and transforming into Heat, distinguishing new-onset from chronic cases. One type involves Phlegm-Fluids in the diaphragm; another involves Parasite accumulation in the middle, distinguishing vomiting of phlegm-fluids from clear water. One type is Qi stagnation; another is Food retention, distinguishing abdominal distension (Zhang) from fullness (Man). One type is Blood stasis; another is Fire excess, distinguishing preference for heat from preference for cold. One type is Deficiency, which differs from Excess in that it may involve a desire or aversion to pressure. However, these are merely general categories. Fundamentally, Stomach Qi is what sustains human life; it relies on the Middle Jiao to rot and ripen food, and borrows Spleen Qi to digest it. If obstruction occurs and normal vigorous transportation is lost, then Qi and Blood stagnation, Food retention, and Phlegm-Fluids can take advantage of this to cause harm. If one only knows how to treat the symptoms without exploring the root cause, the body will become increasingly deficient with each attack. Although there may be slight relief in the short term, it actually lays the foundation for future illness, leading to immediate recurrence upon trigger and worsening over time. This is likely due to inappropriate treatment.
Therefore, whenever treating Spleen/Stomach pain, if the pulse is weak, indicating that Middle Qi is already deficient, one should immediately use Guipi Tang (Restore the Spleen Decoction), but remove Danggui (Angelicae Sinensis Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma), add a small amount of Chaihu (Bupleuri Radix), or combine it with Erchen Tang (Two-Cured Decoction). If there is Food retention, add Zhishi (Immature Bitter Orange); if there is Cold, add Paojiang (Prepared Ginger); if there is Heat, add Shanzhi (Gardeniae Fructus). By first consolidating Middle Qi, pain will not damage the Stomach. If Spleen Yin is not exhausted, Stomach Yang has support; the Heart Mind (Shen) becomes tranquil, and the Liver dare not invade; how could the Kidney alone dominate? In this way, multiple benefits are achieved at once. As for treating Excess patterns, methods are detailed in medical texts.
1. Guest Cold invading the Stomach, or excessive consumption of raw/cold foods causing Middle Epigastric pain, cold limbs, and a wiry-tight pulse: use Caodoukou Tang (Grass Cardamom Decoction).
2. Heart pain persisting for some time, where Cold stagnates and transforms into Heat, presenting with irritability, vomiting of sour fluid, red face, and rapid pulse: use Shanzhiren Tang (Gardenia Seed Decoction).
3. Phlegm-Fluids in the chest and diaphragm, with retching, severe unbearable pain, and a surging-slippery pulse: use Zhisuo Erchen Tang (Immature Bitter Orange and Amomum Two-Cured Decoction).
4. Parasite pain that comes and goes, spitting clear water, or feeling like biting: use Chuanlianzi Tang (Toosendan Fruit Decoction).
5. Heart pain triggered by anger, with distension and stuffiness in the heart and diaphragm, deep-hidden pulse, and cold limbs: use Muxiang Tang (Costus Root Decoction).
6. Heart pain caused by consuming hard foods like noodles, leading to indigestion: use Laifuzi Tang (Radish Seed Decoction).
7. Heart pain in patients who prefer hot foods, indicating Blood stasis lingering at the stomach opening: use Taoren Xianyu Tang (Peach Kernel and Corydalis Decoction).
8. Middle Qi deficiency, excessive worry, irregular meals, and unregulated labor: use Guipi Tang (Restore the Spleen Decoction) or Liujunzi Tang (Six Gentlemen Decoction).
[Prescription Formulations]
Caodoukou Tang (Grass Cardamom Decoction)
Caodoukou (Nutmeg Grass Cardamomi Rotundifoliae Semen, roasted), Gaoliangjiang (Alpiniae Officinarum Rhizoma), Guangpi (Citri Reticulatae Pericarpium), Chenshenqu (Medicated Leaven, fried), Wuzhuyu (Evodiae Fructus, soaked in water, 5 fen), Fuling (Poria), Banxia (Pinelliae Rhizoma, each 1 qian), Zhi Gancao (Honey-fried Glycyrrhizae Radix et Rhizoma, 3 fen). Add one piece of roasted ginger. Decoct in water. Do not use lightly unless the pulse is solid and the syndrome is cold.
Shanzhiren Tang (Gardenia Seed Decoction)
Shanzhi (Gardeniae Fructus, charred black), Banxia (Pinelliae Rhizoma), Guangpi (Citri Reticulatae Pericarpium, each 1 qian), Zhuru (Bambusae Caulis in Taenia, one bundle), Muxiang (Costi Radix, 5 fen), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 3 fen), Huanglian (Coptidis Rhizoma, 7 fen, processed with Evodia juice). Add a handful of Jindian (Junci Medulla). Decoct in water.
Zhisuo Erchen Tang (Immature Bitter Orange and Amomum Two-Cured Decoction)
Zhishi (Immature Bitter Orange, bran-fried), Shu Banxia (Prepared Pinelliae Rhizoma, each 1.5 qian), Fuling (Poria), Sharen (Amomi Fructus, roasted), Guang Chenpi (Citri Reticulatae Pericarpium, each 1 qian), Zhi Gancao (Honey-fried Glycyrrhizae Radix et Rhizoma, 3 fen). Add three slices of ginger. Decoct in water.
Chuanlianzi Tang (Toosendan Fruit Decoction)
Chuanliuran (Toosendanii Fructus, 2 qian), Muxiang (Costi Radix, 7 fen), Binglang (Arecae Semen), Shu Banxia (Prepared Pinelliae Rhizoma), Zhishi (Immature Bitter Orange, fermented bean curd-fried), Guangpi (Citri Reticulatae Pericarpium, each 1 qian), Zhi Gancao (Honey-fried Glycyrrhizae Radix et Rhizoma, 3 fen). Decoct with ginger water, mix with a little brown sugar before taking.
Muxiang Tang (Costus Root Decoction)
Muxiang (Costi Radix), Xiangfu (Cyperi Rhizoma, vinegar-fried), Qingpi (Green Citrus Peel), Guangpi (Citri Reticulatae Pericarpium), Zhishi (Immature Bitter Orange, bran-fried), Chaihu (Bupleuri Radix), Sugeng (Perillae Caulis, each 1 qian), Zhi Cao (Honey-fried Licorice, 3 fen). Add one qian of finely ground roasted Sharen (Amomi Fructus). Decoct in water.
Laifuzi Tang (Radish Seed Decoction)
Laifuzi (Raphini Semen, baked and ground), Shanzha (Crataegi Fructus, each 1.5 qian), Houpo (Magnoliae Officinalis Cortex, ginger-processed), Zhishi (Immature Bitter Orange), Guangpi (Citri Reticulatae Pericarpium, each 1 qian), Pengzhu (Curcumae Rhizoma, 8 fen, vinegar-processed), Zhi Gancao (Honey-fried Glycyrrhizae Radix et Rhizoma, 3 fen). Add three slices of ginger. Decoct in water.
Taoren Yanyu Tang (Peach Kernel and Corydalis Decoction)
Taoren ni (Peach Kernel paste, 10 seeds), Muxiang (Costi Radix), Paojiang (Prepared Ginger, each 5 fen), Zhi Gancao (Honey-fried Glycyrrhizae Radix et Rhizoma, 3 fen), Xiangfu (Cyperi Rhizoma, vinegar-fried), Yanhusuo (Corydzalis Rhizoma, vinegar-boiled), Guangpi (Citri Reticulatae Pericarpium, each 1 qian), Gouteng (Uncariae Ramulus cum Uncis), Zelán (Lycopersici Herba, each 1.5 qian). Add 5 fen of Sharen (Amomi Fructus). Decoct in water.
Guipi Tang (Restore the Spleen Decoction)
Renshen (Ginseng Radix), Shihu (Dendrobii Caulis, salt-water fried), Yuanzhiren (Polygalae Radix, cleaned and baked with licorice water), Fushen (Poria with Hostwood), Zaoren (Ziziphi Spinosae Semen, roasted and ground), Baizhu (Atractylodis Macrocephalae Rhizoma, earth-fried, each 1 qian), Paojiang (Prepared Ginger), Muxiang (Costi Radix), Shichangpu (Acori Tatarinowii Rhizoma, each 5 fen), Chaihu (Bupleuri Radix), Zhi Gancao (Honey-fried Glycyrrhizae Radix et Rhizoma, each 3 fen), Dangguishen (Angelicae Sinensis Radix, 7 fen). Add five pieces of Guiyuanrou (Longan Aril). Decoct in water.
Liujunzi Tang (Six Gentlemen Decoction)
Renshen (Ginseng Radix), Banxia (Pinelliae Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma, earth-fried), Fuling (Poria), Guangpi (Citri Reticulatae Pericarpium, each 1 qian), Gouteng (Uncariae Ramulus cum Uncis, 1 qian), Muxiang (Costi Radix, 5 fen), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 3 fen). Add two dates and three slices of ginger. Decoct in water.